Introduction
In the World Health Organization’s (WHO) list of health challenges in the current decade, substance use is listed as one of the challenges affecting young people.1 Substance use is defined as “the use of selected substances, including alcohol, tobacco products, drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects.”2 According to the World Health Organization, substances including alcohol, opioids, and cocaine, which are mood-altering when consumed, are called psychoactive substances.3 The use of these substances, however, can deteriorate into abuse with health complications, which may include increased risk of non-communicable diseases such as cardiovascular disease, cancer, liver disease, increased risk of suicidal tendency, depression, anxiety, reduced productivity, and antisocial behavior.1,4,5 The World Health Organization asserts that about 36.7 million Disability Adjusted Life Years (DALYs) were lost globally in 2019 due to nonmedical use of psychoactive drugs, and 115.9 million DALYs were lost due to alcohol consumption.3
According to the World Population Review, substance use is more prevalent in the developed world with countries such as the USA, the UK, and Greenland reporting that 5% or more of their population uses illicit substances.6 However, individuals in low- and middle-income countries are more likely to experience complications related to substance use because of limited access to appropriate interventions.7 Globally, only one in eight substance users who need treatment receive it because resources are very limited in low- and middle-income countries.7
The most used psychoactive substance is alcohol, and young people are disproportionately affected more than older people.3,7 The United Nations estimates that there are approximately 28 million substance users in Africa, and, globally, alcohol contributes to the loss of approximately 42 million years of healthy life.8,9,10 Students make up a large percentage of substance users, with some studies reporting prevalence as high as 84.5% among university students in Africa.11 Students are known to use illicit substances to aid in academic efficiency, to cope with their difficult circumstances, for recreation, and excitement.12 Abate, Chekol, & Minaye found that across all universities in Ethiopia, approximately 16.2%-72.6% of students were misusing substances such as alcohol, khat, bhang, and other psychoactive substances.13 In East Africa, 48.99% of young people in universities were found to misuse substances.13 Uganda, a low-income country with a large youth population, is a leading East African nation in alcohol consumption with a prevalence rate of 28.6%.14,15 Approximately 20% of admissions to Butabika National Psychiatric Referral Hospital are attributed to alcohol and other drug-related issues.16,17 The misuse of substances among adolescents and young adults is a public health problem in Uganda and slows down progress toward SDG 3.5 target: to strengthen the prevention and treatment of substance abuse.17,18 Access to substances, especially alcohol, in Uganda is easy because of limited regulation, with approximately 52% of alcohol being manufactured by the unregulated informal sector, and it is widely available in all retail outlets for anyone who can afford to buy it.17 There is a Narcotics and Psychotropic Control Act with harsh punishments for illegal possession and use of opioids, but implementation has not yet yielded significant results.19
Religiosity and substance use
Multiple studies show an inverse relationship between substance use and religiosity, but the mechanisms underlying this relationship are not well understood.20,21 Uganda Christian University (UCU), founded by the Anglican Church in 1997, is a top private university whose core values are underpinned by Christian principles.22 The University has a student population of more than 4,000 students in each of its three semesters a year. In the UCU Alcohol and Other Drugs Abuse Policy, nonmedical use of psychoactive substances, specifically alcohol and drugs such as cocaine, is prohibited.23 Data on substance use in Africa is limited, and there is scarcity of literature explaining the spiritual determinants of health in African countries and yet, many studies found that religiosity has a positive, protective effect on substance use and health in general.8,21,24,25,26 Previous analyses on substance use among university students have been mainly focused on South African countries, Ethiopia and Nigeria, with fewer studies on East African countries such as Uganda.13,25,27 This study measured the point prevalence of substance use among undergraduate students at the Uganda Christian University’s’ Main Campus at Mukono, Kampala Campus, and the Medical and Dental Schools at Mengo Hospital during the January/May semester of 2024. The study also assessed the role of faith, religion, and spirituality in substance use among UCU students.
Methodology
Study design
A quantitative cross-sectional approach was used to measure the point prevalence of substance use and to assess the role of religiosity in substance use among UCU undergraduate students. In this study, religiosity was defined as encompassing three dimensions: religion (participation in organized practices), faith (personal belief in a divine being), and spirituality (a sense of connection to the transcendent). The Social Ecological Model guided the design of the study. Religious factors impact decision-making and behavior at multiple levels, including individual (religious practices), interpersonal (family, close friends, wider social network including the church family), organizational (campus environment), community (cultural norms and church practices), and policy (government). Spirituality, faith, and religion impact health behaviors both directly and indirectly through psychological, social, and emotional factors.28,29
Study setting
The main campus of Uganda Christian University (UCU) is located in Mukono, 21 kilometres east of Kampala with several regional campuses across Uganda. The majority of UCU students are mostly found at the UCU main campus, the Kampala campus, and the Dental and Medical schools at Mengo Hospital located within Kampala. The University runs on a three-semester system where each academic year is divided into Easter Semester (January to April), Trinity Semester (May to August), and Advent Semester (September to December). The university has four faculties and seven schools, which for the purpose of this study, were re-categorized into five, including the School of Law; School of Business; Technical and Applied Sciences (Faculty of Engineering, Design & Technology and Faculty of
Agricultural Sciences); Humanities and Social Sciences (Bishop Tucker School of Divinity & Theology, School of Education and School of Journalism, Media & Communication); and Health Sciences (School of Medicine, School of Dentistry and Faculty of Public Health, Nursing and Midwifery). Each semester has an average of approximately 4000 students with a female to male ratio of 52:48 and with an average undergraduate age of 21 Years.
Participants
The participants were undergraduate students randomly selected from all the schools and faculties of the University at Main Campus Mukono, Kampala Campus and the Medical and Dental Schools at Mengo Hospital during Easter semester of 2024. The focus was on undergraduate students because studies in Africa show that young people aged 15-24 are the most frequent substance users.7,30 The inclusion criteria were all the UCU undergraduate students in their 2nd up to 10th semesters, registered in the data centre, studying at the UCU Main Campus in Mukono, Kampala Campus, and the Medical and Dental Schools at Mengo Hospital during Easter semester of 2024. The optimal sample size of 366 participants was determined using a formula for estimating proportions in cross-sectional studies,31 with a population size of 4,000, a prevalence of 49%, α = 0.05, and error tolerance of 5% (0.05).13 To account for potential incomplete or poorly filled questionnaires, the calculated sample size was increased by 15%, resulting in a target sample size of 420 participants.
Sampling
Stratified random sampling was used to obtain a representative sample. To improve representation and enable sub-group comparison, the students in the sampling frame were stratified according to the schools/faculties at Uganda Christian University. After stratification according to school/faculty, systematic random sampling was applied after working out an appropriate sampling interval in each of the faculties according to the proportion of students in each stratum. If a particular respondent was not available or did not agree to take part in the study, the next option on the list was selected.
Data collection
A self-administered questionnaire in English, adapted from validated tools, including The Duke University Religion Index (DUREL),32 the WHO Alcohol Use Disorders Identification Test (AUDIT),33,34 and the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST),35 was pre-tested and converted into a Google form. The digital form included an automated completeness check. The form was then shared with the selected participants to complete and submit online. Sharing of the Google form occurred only after informed consent was obtained from each participant via telephone.
Data analysis
Data from the participants was received in a Google sheet, which was examined and cleaned of data entry errors and then exported to Python Version 3.12 for descriptive analysis of demographics, prevalence of substance use, and spirituality and religiosity of participants. Logistic regression was done to assess the relationship between substance use, demographics, religion, faith and spirituality. Odds ratios and confidence intervals were used to interpret logistic regression results. Chi-square was used to test the association between categorical variables. In this study, substance use was defined according to the WHO as “consumption of any psychoactive substance regardless of its controlled status.”36
Results
The number of randomly selected participants who submitted a self-administered Google form questionnaire was 407 out of the targeted sample of 420. All the submitted Google form questionnaires were useable. This gave a completion rate of approximately 97%. Table 1 shows participants were in the age range of 19-24 (82.6%) and the mean age with a standard deviation was 23.52 (4.35) with a range of 19-58 and median of 22 years. The majority of participants came from the Law School (35.5%) and the School of Business (21.1%). Most participants had been students at the university for more than a year (77.6%). Females comprised 59.7% of the participants. A total of 69.5% of the participants reported having relatives who used substances, while 61.9% had one relative and 7.6% had multiple relatives using substances. Anglicans (48.9%), Catholics (23.6%), and Pentecostals (20.4%) were the predominant religious affiliations. Most respondents resided in private hostels (41.0%) off campus or in campus/university affiliated hostels (32.4%).
Table 1
Participant demographics
| Variable | Category | Frequency (n=407) | Percentage | |
|---|---|---|---|---|
| Age in completed years | 19–24 | 336 | 82.6 | |
| 25–34 | 56 | 13.8 | ||
| ≥ 35 | 15 | 3.7 | ||
| Faculty / School | School of Law | 144 | 35.4 | |
| School of Business | 86 | 21.1 | ||
| Technical and Applied Sciences | 74 | 18.2 | ||
| Humanities and Social Sciences Schools | 59 | 14.5 | ||
| Health Sciences | 44 | 10.8 | ||
| Sex | Female | 243 | 59.7 | |
| Male | 164 | 40.3 | ||
| Duration at the University | 3 years | 133 | 32.7 | |
| Less than 1 year | 91 | 22.4 | ||
| 1 year | 77 | 18.9 | ||
| 4 years & over | 61 | 15.0 | ||
| 2 years | 45 | 11.1 | ||
| Is there anyone in your family that drinks alcohol or uses drugs? | someone in my extended family | 151 | 37.1 | |
| No family member drinks alcohol or uses drugs | 124 | 30.5 | ||
| sibling | 54 | 13.3 | ||
| parent | 47 | 11.5 | ||
| Relatives (multiple) | 31 | 7.6 | ||
| How often do you have a drink containing alcohol? | Never | 282 | 69.3 | |
| Monthly or less | 91 | 22.4 | ||
| 2-4 times a month | 29 | 7.1 | ||
| 2-3 times a week | 4 | 1.0 | ||
| 4 or more times a week | 1 | 0.3 | ||
| Religious affiliation | Anglican | 199 | 48.9 | |
| Catholic | 96 | 23.6 | ||
| Pentecostal | 83 | 20.4 | ||
| Seventh Day Adventist | 14 | 3.4 | ||
| Islam | 9 | 2.2 | ||
| Other | 6 | 1.5 | ||
| Residential Status | Private Hostel | 167 | 41.0 | |
| Resident on campus / University affiliated hostel | 132 | 32.4 | ||
| I commute from home | 65 | 16.0 | ||
| I rent a room / a house | 43 | 10.6 | ||
Table 2 shows the prevalence of alcohol and other substances was 36.7%. The most frequently used substance was alcohol with a prevalence of 30.8%, of which 22.9% of participants used alcohol exclusively. The prevalence of other substances was 13.8%, with 5.9% using substances excluding alcohol. The participants were classified according to the WHO Alcohol Use Disorder Identification Test34 with the majority (87.47%) categorized as low risk and 12.53% were identified as engaging in risky to harmful alcohol use. The prevalence of participants who used multiple types of substances was 7.9%. Other substances used by participants without the use of any alcohol were tobacco products (3.4%) and cannabis (2.5%).
Table 2
Prevalence and AUDIT levels
| Variable | Category/Level | Count (n=407) | Percentage | |
|---|---|---|---|---|
| Substance use | Never used any substance | 258 | 63.4 | |
| Alcohol only | 93 | 22.9 | 36.7 prevalence of overall substance use | |
| Multiple substances including alcohol | 32 | 7.9 | ||
| Other substances only | 24 | 5.9 | ||
| Breakdown of other substances | Tobacco products only (cigarettes, chewing tobacco, cigars, shisha, etc.) | 14 | 3.4 | 5.9 prevalence of other substances |
| Cannabis only (marijuana, pot, grass, hash, etc.) | 10 | 2.5 | ||
| AUDIT Risk of alcohol use disorders | Low risk | 356 | 87.47 | |
| Risky | 44 | 10.81 | ||
| Dependence | 4 | 0.98 | ||
| Harmful | 3 | 0.74 |
Table 3
Logistic regression of demographic predictors of substance use
| n = 407 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Variable | Levels | Bivariate analysis | Multivariable analysis | VIF | ||||||
| Coefficient | p-value | COR | CI [95%] | Coefficient | p-value | AOR | CI [95%] | |||
| Intercept | n/a | -1.913 | p-value < 0.001 | 0.148 | (0.072, 0.303) ** | n/a | ||||
| Sex | Female | |||||||||
| Male | 0.436 | 0.037 | 1.546 | (1.026, 2.329) ** | 0.492 | 0.038 | 1.636 | (1.027, 2.607) ** | 1 | |
| Faculty / School | School of Law | 1 | 1 | |||||||
| School of Business | -0.424 | 0.13 | 0.654 | (0.375, 1.140) | ||||||
| Technical and Applied Sciences | -0.303 | 0.30 | 0.739 | (0.415, 1.315) | ||||||
| Humanities and Social Sciences Schools | -0.916 | 0.009 | 0.4 | (0.202, 0.793) ** | ||||||
| Health Sciences | -0.308 | 0.386 | 0.735 | (0.366, 1.475) | ||||||
| Residential status | I rent a room / a house | 1 | ||||||||
| I commute from home | -0.671 | 0.099 | 0.511 | (0.230, 1.135) | 1 | |||||
| Resident on campus/University affiliated hostel | -0.880 | 0.016 | 0.415 | (0.203, 0.847) ** | -0.856 | 0.04 | 0.425 | (0.214, 1.318) ** | ||
| Private Hostel | -0.089 | 0.796 | 0.915 | (0.467, 1.793) | ||||||
| How long have you attended UCU? | 1 year & below | 1 | ||||||||
| 2 years | 0.507 | 0.151 | 1.660 | (0.830, 3.317) | 1 | |||||
| 3 years | 0.840 | < 0.001 | 2.316 | (1.429, 3.752) ** | 0.826 | 0.002 | 2.285 | (1.340, 3.897) ** | ||
| 4 years & above | 0.7083 | 0.0232 | 2.031 | (1.102, 3.743) ** | ||||||
| Family Use of Alcohol or Drugs? | No family member drinks alcohol or uses drugs | 1 | ||||||||
| Parent | 1.437 | < 0.001 | 4.208 | (2.029, 8.728) ** | 1.304 | 0.001 | 3.682 | (1.681, 8.065) ** | 1 | |
| Relatives (multiple) | 2.222 | < 0.001 | 9.222 | (3.83, 22.204) ** | 2.158 | < 0.001 | 8.652 | (3.296, 22.712) ** | ||
| Sibling | 1.028 | 0.005 | 2.795 | (1.374, 5.685) ** | 0.904 | 0.018 | 2.467 | (1.166, 5.232) ** | ||
| Someone in my extended family | 1.091 | < 0.001 | 2.976 | (1.705, 5.197) ** | 1.147 | 0.0001 | 3.15 | (1.743, 5.694) ** | ||
| What is your religious affiliation? | Anglican | 1 | ||||||||
| Catholic | 0.756 | 0.003 | 2.131 | (1.298, 3.496) ** | 0.711 | 0.010 | 2.036 | (1.186, 3.495) ** | 1 | |
| Pentecostal | -0.843 | 0.008 | 0.431 | (0.232, 0.799) ** | -0.848 | 0.0121 | 0.428 | (0.221, 0.830) ** | ||
| Other (including Islam & SDA) | -0.053 | 0.9 | 0.949 | (0.418, 2.152) | ||||||
Using logistic multivariate analysis (Table, sex [(AOR = 1.636, 95% CI=1.027, 2.6069), p=0.0382], residential status [(AOR=0.425, 95% CI=0.2144 , 1.3176), p=0.04], multiple family member use of substances [(AOR = 8.652, 95% CI=3.2961 , 22.7122), p=0.001], duration at UCU [(AOR=2.2848, 95% CI=1.3398 , 3.8966), p=0.024], and affiliation with Catholicism [(AOR=2.036, 95% CI=1.1864 , 3.4947), p=0.0099] were all significantly associated with substance use. Males were approximately 1.64 times more likely to use substances than females. Participants who were resident on campus or university-affiliated hostels were 57.5% less likely to use substances which suggested a protective effect. Participants with multiple family members using substances were 8.7 times more likely to use substances than those with no family history of substance use. Students who identified as Catholic were twice more likely to use substances than the Anglicans, and Pentecostalism was protective against substance use compared to Anglicanism [(AOR=0.428, 95% CI=0.221, 0.8304), p=0.0121]. Being a student in schools/ faculties other than the School of Law, was protective based on the bivariate analysis with those in Humanities and Social Science Schools with the largest protective effect [(AOR=0.4, 95% CI=0.2018, 0.7929), p=0.0087]. The multivariable analysis did not show an association by School/Faculty. Participants who had been students at UCU for three years were more likely to use substances than those who had been there for less than a year [(AOR=2.285, 95% CI=1.3398, 3.8966), p=0.0024]. Being a student at UCU for more than four years was significantly associated with substance use [(COR=2.031, 95% CI=1.1015, 3.7431), p=0.0232] but not in the multivariable analysis. A Variance Inflation Test (VIF) of 1 indicated no correlation among predictor variables in the model, which suggests no multi-collinearity issues. At bi-variate level, all dimensions of religiosity, as measured by the DUREL, have a significant protective effect on substance use among study participants. Table 4 shows the multivariable analysis of the religiosity dimensions of religion [(AOR=0.4485, 95% CI = 0.2169, 0.9275) P=0.0305] and faith [(AOR=0.5025, 95% CI=0.2544, 0.9924), P=0.0475], each being independent of other variables, are significantly protective against substance use. A Variance Inflation Test (VIF) of 1 indicated no correlation among predictor variables in the model suggesting no multi-co linearity issues.
Table 4
Logistic regression of the Duke University Religion Index (DUREL) as predictors of substance use among UCU undergraduates
| n = 407 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Variable | Levels | Bivariate analysis | Multivariable analysis | VIF | ||||||
| Coefficient | p-value | COR | CI [95%] | Coefficient | p- value | AOR | CI [95%] | |||
| Intercept | n/a | 0.637 | 0.132 | 1.891 | (0.826, 4.331) | n/a | ||||
| Time spent in private religious activities (Spirituality) | Rarely or never | 1 | ||||||||
| Few times a week | -0.522 | 0.049 | 0.594 | (0.353, 0.998) | ||||||
| Once a day | -0.759 | 0.013 | 0.468 | (0.257, 0.854) | 1 | |||||
| More than once a day | -1.225 | < 0.001 | 0.294 | (0.162, 0.532) | ||||||
| How often attend religious meetings (Religion) | Rarely or never | 1 | ||||||||
| A few times a month | -0.092 | 0.792 | 0.913 | (0.462, 1.802) | ||||||
| Once a week | -0.575 | 0.063 | 0.563 | (0.307, 1.031) | 1 | |||||
| More than once a week | -1.412 | < 0.001 | 0.244 | (0.131, 0.452) ** | -0.802 | 0.031 | 0.449 | (0.217, 0.928)** | ||
| Importance of religious beliefs (Faith) | Not true | 1 | ||||||||
| Somewhat true | -0.102 | 0.753 | 0.904 | (0.480, 1.701) | ||||||
| I Definitely true | -1.155 | < 0.001 | 0.315 | (0.186, 0.533) ** | -0.688 | 0.048 | 0.503 | (0.254, 0.992) | 1 ** | |
| Experience the presence of God (Spirituality) | Not true | 1 | ||||||||
| Somewhat true | -0.505 | 0.318 | 0.604 | (0.224, 1.624) | ||||||
| Definitely true | -1.064 | 0.005 | 0.345 | (0.165, 0.724) ** | 1 | |||||
| Religion carries over into life. (Religion) | Not true | 1 | ||||||||
| Somewhat true | 0.095 | 0.769 | 1.1 | (0.581, 2.082) | ||||||
| Definitely true | -1 | 0.0003 | 0.368 | (0.214, 0.632) ** | 1 | |||||
Discussion
The objectives of this study were to determine the prevalence of substance use among undergraduates at Uganda Christian University and to describe the role of faith, religion, and spirituality in substance use. This survey had a completion rate of 97% (407/420) which was higher than expected. The design of the Google form, which included a completeness check, may have contributed to a high response rate, as all the returned questionnaires were useable. Stratified random sampling, with the number of participants who were chosen from each stratum proportionate to the size of the schools/ faculties, ensured that the sample in terms of demographic variables was a reflection of the typical UCU undergraduate student. For example, there were more females (59.7%) than males and most respondents were selected from the schools of law (35.5%) and business (21.1%), which according to the UCU data centre, contribute more than 50% of the undergraduate students at UCU. The respondents’ mean age was 23.52 years. The data exhibited a right skew, with a median age of 22 years, reflecting that most participants were younger than the mean. There was a minority of participants with ages of up to 58 years, primarily from the School of Theology. Priests tend to go for their undergraduate studies as adult learners. This minority of older participants pulled the mean upwards. The median age of 22 years falls in the category of young people who were the target demographic for this study. In Africa, studies show that substance use tends to be more common among young adults.7,30 Anglicanism (48.9%) was the predominant religious affiliation, reflecting UCU’s foundation by the Anglican Church of Uganda and its alignment with the University’s Christ-centered core values. However, the university is open to all other religious affiliations including Catholics, Muslims, Seventh Day Adventists, Pentecostals, and others.
Prevalence
The substance use prevalence of 36.7% by young people in this study was much higher than the lifetime prevalence of any substance use of 21% pooled from 53 studies in Sub Saharan Africa.37 However, in the same systematic review and meta-analysis of related studies, the country-specific studies showed that current substance use among young people in Uganda was 75%, much higher than what was found in this study. Uganda Christian University strongly discourages substance use. The Chaplaincy and health promotion initiatives led by the Health and Safety Committee, as well as the UCU Alcohol and Other Drugs Abuse Policy (AOD) are in place to designates campuses as substance free zones.23 Thus, a lower prevalence of substance use was anticipated. A systematic review and meta-analysis of studies on lifetime use of substances among students in Ethiopia by Roba and others found a high lifetime prevalence of any substances among students at 52.5%, but the studies in the systematic and meta-analysis included both high schools and universities.38 Recent rigorous substance use studies done among university students in Uganda were limited. The prevalence of substance use in the reviewed studies among university students in Uganda, ranged from 30% to 56.82%.39,40
The most frequently used substance among the UCU undergraduate students was alcohol with a prevalence of 30.8% consistent with existing literature.37,38,40,41 A major contributor to the high prevalence of alcohol use is the failure to regulate its availability in Uganda where it is legally acceptable for use by adults aged 21 years and above. The National Alcohol Control Policy envisions “a country free of harmful use of alcohol and its consequences.”17 However, weak implementation of the policy has allowed alcohol to be easily available in bars, shops, and supermarkets across the country with little or no restrictions on access even for under-age individuals. On the UCU campuses, alcohol is not easily available because of the University’s Christian Identity and the AOD policy.23 However, most students (>67%) stay off campus where alcohol is easily available, and this study showed that students staying off campus were more likely to use substances than those staying on campus X2 (2, N=407) = 15.53, p<0.001.
Responses to the AUDIT categorized 12.53% of the participants as engaging in risky to harmful use of alcohol. Harmful use of alcohol is linked to numerous health risks which include behavioral issues, injuries, harm to others, social problems, and an increased likelihood of infectious diseases such as HIV.3 Some of the participants in this study (7.9%) reported multiple use of substances including alcohol, tobacco products, and cannabis. Concurrent use of alcohol and other substances is known to be associated with more adverse health risks and reduced compliance with available support.42,43,44The concurrent users of alcohol and other substances would likely benefit from customized support measures.
Demographic effects on substance use
Age was not found to be significantly associated with substance use in this population, which differs from what other researchers found in similar studies.30,7 The males in this study were found to be 63.6% more likely to use substances than females (p= 0.0382). The mechanism of this sex difference in substance use is not well understood, but it is known that sex affects behavior and perception.45 This study found that males were more likely to use substances than females. This aligns with the observation that female participants tended to be more religious and religiosity is known to be protective against substance use.21,46,47,48,49,50 However, substance use is multifaceted, for example, some studies show that trauma including sexual violence increases the likelihood of women using substances.65
Students attending Humanities and Social Sciences, which include the Schools of Education, School of Journalism, School of Social Sciences, and Bishop Tucker School of Divinity and Theology, were 40% less likely to use any substance compared to those in the School of Law (p=0.0087). This may reflect Humanities and Social Sciences’ professional codes of conduct that discourage use of substances. However, multivariable analysis adjusting for potential confounders, the association lost statistical significance suggesting that there may be other factors like stress levels which may vary across professional programs; stress levels were not measured in this study. Participants who had attended UCU for 3 years were 2.285 times more likely to use substances than those who had attended the university for less than a year. This association was significant (p=0.0024) and the majority of third-year students at UCU are likely to be under pressure in order to complete their courses and stress is a known contributing factor to substance use.12,51,52
Participants with a relative using substances were significantly more likely to do the same compared to those without such a relative, especially when multiple relatives or a parent were substance users (AOD 8.65, p=0.0182). This finding is consistent with studies showing that use of substances by parents, siblings, or other members of the household is a risk factor for substance use by young people.53,54,55 Participants who were residents on campus were less likely to use substances compared to those staying off campus (p=0.04). Several published studies report a similar association between living off campus and a higher likelihood of substance use.56,57,58,59 This finding was not unexpected given the fact that the alcohol and other drugs policy designates the UCU campuses to be substance free zones. Regarding religious affiliation, Catholics were twice as likely to use substances compared to Anglicans (p=0.0099) and Pentecostals were 43% less likely to use substances than Anglicans (p=0.0121). The Catholic Church Catechism discourages excess use of alcohol, food, and medicines, but it promotes temperance, and alcohol is seen as gift to be enjoyed responsibly.60 Anglicans and Pentecostals, have different opinions on alcohol use (Mirror, 2015).60,61 The Anglican Church of Uganda and Pentecostal churches in Uganda discourage use of alcohol, viewing it as harmful due to its potential for misuse and the associated negative consequences.
Uganda Christian University aims to prepare students for productive lives of Christian faith and service, with core values rooted in Christ-centeredness with faith and learning integrated in the curricula and in all extra-curricular activities.22 Consequently, the predominant religious affiliations in this study were Anglicans (48.9%), Catholics (23.6%), Pentecostals (20.4%), and Seventh Day Adventists (3.4%). At UCU, the chaplaincy plays a central role in nurturing a prayer-centered culture by organizing regular religious services, cell meetings, opening prayers at formal gatherings, and providing spiritual counseling. This creates an atmosphere where students are consistently encouraged to participate in religious activities. As a result, more than 70% of the participants reported high levels of religiosity which is associated with health protecting behaviors and attitudes.21,46,47,48,50,54,49,62
The role of religion, spirituality and faith in substance use
The bivariate analysis (Table 4) identified that religion, spirituality, and faith each had a significantly protective effect against substance use. In the multivariable analysis, both religion and faith, individually, demonstrated a protective effect, with adjusted odds ratios (AOR) of 0.4485 (95% CI: 0.2169–0.9275, p=0.0305) and 0.5025 (95% CI: 0.2544–0.9924, p=0.0475), respectively. This finding is not surprising given the numerous studies showing that religiosity has a health protective effect.21,46,47,48,50,54,49,62 Participants in this study showed high levels of religiosity (Table 4) and analysis of their responses to statements on prevention and treatment showed that they preferred faith-based interventions. This creates a favourable environment for designing and implementing faith-based substance use prevention and management interventions. Faith-based interventions have been found to be effective in substance use prevention and management, especially in populations with high religiosity.24,63,64 However, the fact that not all participants favoured faith-based interventions implies that the interventions should be flexible so that options for those who are not religious are also available.
Limitations
This study has several limitations. First, data were self-reported by participants from a Christian university with strict substance use policies, which risks social desirability bias such as underreporting substance use or overreporting religiosity. Findings may, thus, be context-specific to faith-based institutions and not generalizable to secular or other religious settings. Further research in diverse populations, including secular and non-Christian religious communities, is recommended. Second, while validated scales were used (AUDIT, ASSIST, DUREL), potential limitations include: (i) Construct contamination in AUDIT/ASSIST due to items assessing mental health-related consequences, for example guilt, which may inflate associations with religiosity; (ii) DUREL’s potential confounding with unmeasured protective factors, for example social support. Future studies should employ longitudinal designs and advanced statistical methods to clarify causal relationships and reduce confounding.
Conclusion
The overall prevalence of substance use among undergraduate students at UCU was 36.7% with alcohol the most used substance at 30.7%. The AUDIT identified 12.53% as engaging in risky to harmful use while the majorities were identified as low risk to alcohol use disorders. Multiple substance use was reported by 7.9% and the most used other substances were tobacco products at 3.4% and cannabis at 2.5%. The risk factors for substance use among the UCU undergraduate students included being male, duration of stay on campus, rarely or never attending church services or religious activities, making life decisions or choices without reference to faith, and staying off campus. Students identifying as Catholics or having a family history of substance use were also at an increased risk. Protective factors included being female, residing in a campus hostel or university-affiliated hostel, attending religious activities more than once a week, making decisions grounded in faith, identifying as Anglican or Pentecostal, and coming from a substance-free, family background. University leadership should develop targeted programs for third- and fourth-year undergraduates by expanding campus-affiliated housing; integrating faith-based, cell groups; providing on-site chaplaincy support in hostels; and establishing prayer spaces to nurture spiritual growth.
Funding
The funding for this project came from the Meros Center Small Projects Fund and Uganda Partners.
Conflict of interest
The authors have no competing interests to declare that are relevant to the content of this article
Ethical Approval
The study protocol was approved by the Uganda Christian University Research Ethics Committee (UCUREC-2023-723) and the Uganda National Council of Science and Technology (Ref: HS3577ES). Written administrative clearance was obtained from the university administration.
Informed Consent
Verbal informed consent was secured from all participants via telephone.
Acknowledgement
We sincerely thank the participants who shared their time and insights, making this study possible. We also acknowledge the support of Uganda Christian University, whose partnership allowed this research to happen. The study team would also like to acknowledge the research assistants who helped with data collection throughout the project.